Coding Specialist II - Clinical Practice Services

The Medical College of Wisconsin, Inc.; United States; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health insurance

Vision, Dental

403B Retirement Package

Paid Holidays

Tuition Reimbursement

Paid Parental Leave

EFAP (Employee & Family Assistance)

Pet Insurance

Onsite Fitness Facility

Job summary

The Medical College of Wisconsin (MCW) seeks a skilled coder/biller to manage CPT and ICD-10 CM coding, resolve denials, and coordinate with physicians and administrators. You will ensure accurate charges, contribute to protocol development, and educate providers on documentation requirements.

Ideal candidates hold CPC/CCS-P/CCA or RHIT/RHIA credentials, with at least 2 years of coding experience. High school diploma required. MCW offers comprehensive benefits and a supportive work environment.

Qualifications

• Knowledge of CPT and ICD-10 CM coding, and modifiers.
• Understanding of medical insurance guidelines and governmental policies.
• Detail oriented with strong data accuracy requirements.
• Ability to establish and maintain effective working relationships with staff.
• Meet or exceed established production rate and performance standards.
• Proactive in addressing provider documentation trends affecting coding.

Responsibilities

• Charge processing: CPT/ICD-10 CM coding verification and modifiers.
• Reconciliation of charges: monitor flow and resolve missing information.
• Denials/billing issues: identify, report, and resolve coding problems.
• Develop and maintain protocols for assigned areas.
• Provider education and orientations on documentation policies.

Skills

CPT coding

ICD-10 CM coding

Insurance guidelines

Government policies understanding

Progressive computer skills

Detail oriented

Team collaboration

Production expectations

Education

High school diploma

CPC/CPC-A/CCS-P/CCA certification

RHIT/RHIA credential

Office experience (preferred)

Job description

Summary

Perform coding and related duties using established billing office policies in an accurate and timely manner. Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff. Coordinates professional service billings for selected clinical departments. All remote work must be performed within one of the MCW registered payroll states, which currently includes: WI, AL, AZ, DE, FL, GA, IN, MD, MI, MN, MO, NC, TN, TX, & UT.

Primary Responsibilities

CHARGE PROCESSING: Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. (Inpatient/Emergency Department abstraction, ambulatory coding and/or surgical/procedural coding) Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied. Charge Entry as needed.

RECONCILIATION OF CHARGES

Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate change flow. Work with clinic staff and physicians regarding missing or unclear information that is required for billing.

CLAIM DENIALS / BILLING ISSUES

Identify, report, and resolve coding and reimbursement issues. Working with physicians, department administrators and other billing office staff, including reimbursement staff. Identify opportunities to reduce denials and enhance revenue.

PROTOCOLS

Develop and maintain all protocols related to their assigned areas.

PROVIDER EDUCATION

Maintain understanding all Teaching Physician and provider documentation policies. Actively participate in new provider orientations. Note and address trends in provider documentation that may impact coding and billing.

Knowledge – Skills – Abilities

Working knowledge of CPT and ICD-10 CM coding. Understanding of medical insurance guidelines and governmental policies. Progressive computer skills. Detail oriented. Ability to establish and maintain effective working relationships with the team and department staff (including administrative staff and faculty). Meet or exceed established production rate and performance standards.

Qualifications

Appropriate experience may be substituted for education on an equivalent basis.

Minimum Required Education

High school diploma

Minimum Required Experience

2 years of related coding experience

Preferred Experience

Office experience

Required Certification/Licensure(s)

Coding certification (CPC, CPC-A, CCS-P, or CCA) and/or Health Information Management credential (RHIT or RHIA).

Physical Requirements

Work requires occasionally lifting moderate weight materials, standing, or walking continuously. Work Environment Occasional exposure to dust, noise, temperature changes, or contact with water or other liquids. Work is performed in an environmentally controlled environment. Sensory Acuity Ability to detect and translate speech or other communication required. May occasionally require the ability to distinguish colors and perceive relative distances between objects.

Why MCW?

• Outstanding Healthcare Coverage, including but not limited to Health, Vision, and Dental.
• Along with Flexible Spending options
• 403B Retirement Package
• Competitive Vacation and Paid Holidays offered
• Tuition Reimbursement
• Paid Parental Leave
• Employee & Family Assistance Program (EFAP)
• Pet Insurance
• On campus Fitness Facility, offering onsite classes
• Additional discounted rates on items such as: Select cell phone plans, local fitness facilities, Milwaukee recreation and entertainment etc.

For a brief overview of our benefits see: Benefits Overview For a full list of positions see: MCW Careers At MCW all of our endeavors, from our internal operations to our interactions with our partners, are driven by our shared organizational values: Caring – Collaborative – Curiosity – Inclusive – Integrity – Respect. We are committed to fostering an inclusive environment that values diversity in backgrounds, experiences, and perspectives through merit-based processes and in alignment with all applicable laws. We believe that embracing human differences is critical to realize our vision of a healthier world, and we recognize that a healthy and thriving community starts from within. Our values define who we are, what we stand for and how we conduct ourselves at MCW. If you believe in embracing individuality and working together according to these principles to improve health for all, then MCW is the place for you. For more information, please visit our institutional website. MCW as an Equal Opportunity Employer and Commitment to Non-Discrimination: The Medical College of Wisconsin (MCW) is an Equal Opportunity Employer. We are committed to fostering an inclusive community of outstanding faculty, staff, and students, as well as ensuring equal educational opportunity, employment, and access to services, programs, and activities, without regard to an individual's race, color, national origin, religion, age, disability, sex, gender identity/expression, sexual orientation, marital status, pregnancy, predisposing genetic characteristic, or military status. Employees, students, applicants or other members of the MCW community (including but not limited to vendors, visitors, and guests) may not be subjected to harassment that is prohibited by law or treated adversely or retaliated against based upon a protected characteristic.

About Us

Together, we can build a healthier world. A student, an educator, a scientist and a community leader — alone, they can do many things. Together, the question isn’t what they can do, but what can’t they. The Medical College of Wisconsin (MCW) brings together the most inquisitive, passionate minds in science, medicine, education and community engagement to tackle today’s toughest challenges in health and society. Academic medicine is at the center of where scientists, physicians and students work hand-in-hand with the community to ask the most important questions and fuel the cycle of innovation that shapes the future of medicine. Medical College of Wisconsin The tireless pursuit of knowledge and the power of academic medicine is at the core of everything we do at MCW. Bringing together the world’s top scientists and clinicians, inspired students and invested communities, we are driven to solve the most complex challenges in health and society. With around 1,600 full-time and part-time faculty and approximately 3,500 full-time employees, MCW is home to a diverse group of thought leaders working in collaboration to pioneer pathways to a healthier world and drive a continuous cycle of life-changing discovery.